Understanding Treatment Patterns in Prostate Cancer Patients Post-Darolutamide

The 2025 GU ASCO annual meeting included a presentation by Dr. Javier Puente on the PARASEC study, which examines treatment patterns in prostate cancer patients who advanced to metastatic castration-resistant prostate cancer (mCRPC) following darolutamide therapy. Darolutamide, among other androgen receptor inhibitors like enzalutamide and apalutamide, has been shown to extend overall survival in non-metastatic castration-resistant prostate cancer (nmCRPC) patients.

The Importance of Ongoing Research

While these agents significantly prolong metastasis-free and overall survival compared to placebo, nearly every patient eventually progresses to mCRPC. The study fills a critical gap in the understanding of subsequent treatment strategies in the real-world setting, where multiple advanced prostate cancer therapies are available.

Study Details and Findings

The PARASEC study included 85 patients, with a median age of 76 years. Of these, 49 (58%) progressed to mCRPC, and 35 (71%) of them received treatment for their advanced condition. The median number of treatment lines post-progression was 2, with a range from 1 to 5 lines.

The most commonly used drugs were abiraterone in the first line (63%), followed by docetaxel (29%). In the second line, docetaxel (57%) and cabazitaxel (19%) were prevalent, and for the third line, cabazitaxel (33%) and docetaxel (25%) were predominantly used:

In addition to systemic treatments, eleven patients (31%) received palliative radiotherapy, and seven (20%) received osteoclast-targeted therapy, including five with zoledronic acid and two with denosumab after darolutamide:

The following chart highlights the sequence of treatments for mCRPC:

Dr. Puente’s Takeaways

Dr. Puente summarized his findings and highlighted several important points from the PARASEC study:

• Twenty-nine percent of patients who progressed to mCRPC did not receive any treatment after darolutamide. Among those who did, 63% received abiraterone, which contrasts with current European guidelines.
• Only one in five patients received osteoclast-targeted therapy, indicating that optimization is necessary in this area.
• High variability in treatment duration and sequences suggests a lack of consensus in Spanish clinical practice.
• Developing standardized treatment strategies is crucial to maximizing effectiveness in these patients.

Conclusion

This study underscores the importance of continuous research and the need for standardized treatment guidelines to improve outcomes for prostate cancer patients who progress to mCRPC. Dr. Puente’s presentation at the 2025 GU ASCO highlights areas where advancements can make a significant impact in patient care.

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